welcome

By Dr. Bhavin Kathiriya 2nd yr p G Dept. of Kayachikitsa.

 Name :

Sumit trivedi Age : 35 yrs Sex : male Address: Kolkatta, W.Bengal Marital status: Married Occupation: Software Engineer I.P.No: 76912 Date of admission : 02/07/12 Date of discharge : 26/07/12

Pt c/o Low back pain since 10 years, stiffness in the back Inequality in the length of both legs( left leg incresed by 2 inch.) since 2 years. Sometime c/o. pain in both shoulder joints and right hip joint.

 Piles since 2 years

 Patient named of Sumit ,aged 35 was apparently

healthy 9 years back. Gradually in the september 2003 he started having pain in low back and left sacroiliac joint. For this he started taking pain killer. Later in 2004 even after taking pain killer, he couldnt find relief. So he approached a doctor where he was diagnosed he is suffering from ankylosing spondylitis HLA_ b27. He was advised NSAID and certain exercise. He started taking tablets but didnt do the exercises. And the interval of pain started reducing to 2 month.

In 2008 september, he stopped all conservative medicine and started doing accupressure for 6 months but during this his pain aggravated. Now he started having pain in the cervical region radiating down also in the spine. He, now also have stiffness in the spine also. In 2009 January, he stopped accupressure treatment and came to sdm udupi for ayurvedic

treatment under Dr. Muralidhar Sharma Sir. He was given basti, agnichikitisa lepa, kaishor guggulu. But he couldnt appreciate much change so he stopped the treatment and again started with pain killer. During this time he also developed the deformity in left hip joint due to which his range of movements were markedly diminished and their was inequality in length of two legs. The left leg became longer than right. But finding it harmful for the body he thought to take ayurvedic treatment once again so he came to our hospital on 2nd july 2012.

 Nature of pain: diffused, pricking

increases in the morning Interval : 3 months Duration: 1 week Aggravating factor: not specific But he has observed that pain that episode of pain increases in winter Relieving factor: analgesics

No history of fever, gastric disturbance,

No significant past history is recorded. Patient is non diabetic and non hypertensive

 Not a known case of diabetes mellitus and

hypertension

All family members are said to be healthy (wife and 2 daughter). Father and mother stay together.

 Appetite : Good Diet: mixed

Sleep : Normal (7 hrs night )

Bowels : (once/ day, constipated) Micturition : 5-6 times /days Habits : alcohol : Ocasionally

Smoking : 5-6 cigarats/day priviously (stopped since 2011 ) Tea: 2 times/ day

Appearance - Normal Built - Normosthenic Nutrition - Moderatly nourished Cyanosis - ab Pallor - present Icterus - present Oedema - pedal edema; non pitting type Height - 169cms Weight - 75 kg Tongue - coated Lymphadenopathy- ab Gait - limphing Speech - intact

Temp Pulse Resp rate B.P J.V.P.

- 98.6*F - rate 78/min - 22/min - 130/90 mm of Hg - not raised.

CVS EXAMINATIONS1 & S2 heard , no added sounds..

RESPIRATORY SYSTEM EXAMINATIONNormal vesicular breath sounds, no creps , No added sound.

HIGHER MENTAL FUNCTIONS: Intact. Cranial Nerves- Intact Motor and Sensory system- Intact

INSPECTION
Distension of abdomen present Scars : absent Striae :absent Dialated vein : absent Rashes : absent Umbilicus : inverted Contour of the abdomen: symmetrical

COMPLETE BLOOD COUNT Hb WBC ESR 10.5 gms% 16500 cells/cumm 17300 ( 2/7/12) 54 mm/hr 84 ( 2/7/12) Total RBC Platelet count PCV (Hct) MCV MCH MCHC 2.9 millions / cumm 2.6lakhs / cumm 32 % 108 fl 35.5 pg 32.8 gms %

DIFF. COUNT OF WBC N L Eosinophils Monocytes Basophil 80% 16% 4% 0% 0%

 Random Glucose : 71 mg/dl ( 60 -140 ) Blood Urea : 12 mg/dl (10-50)

Serum creatinine : 0.6 mg/dl (0.6-1.4)

Total bilirubin

16.2 mg/dl

Direct Bilirubin
Indirect Bilirubin SGOT

9 mg/dl

(0-0.3)

7.2 mg/dl (0-0.9) 154 U/L ; 152 (2/7/12)

SGPT
Alkaline Phosphate Total Protein

61 U/L; 74
139 U/L 7.2 g/dl

Albumin
Globulin A/G Ratio

3.2 g/dl
4 g/dl 0.8

 Negative ( 25/06/12 )

Negative

Negative

 Alcoholic liver disease? Cirrhosis

? Regeneration modules/ HCC in the left lobe

Mild Splenomegaly ? Portal hypertension

G.B. sludge

27/06/2012 Features suggest the possibility of cirrhosis of liver with moderate Ascites and Minimal left Pleural effusion.

cirrhosis of liver

JAUNDICE WITH distension of abdomen & pedal oedem

PRE HEPATIC

HEPATIC

POST HEPATIC

ANEMIA , FEBRILE ILLNESS , NO BLEEDING

CLAY COLOURED STOOLS, HEREDITARY INFECTIVE CHRONIC COLICY ABDOMEN PAIN MURPHYS SIGN

GILBERTSS SUNDROME

HEPATITIS

ALCOHOL INDUCED DRUG INDUCED

 Clinical diagnosis - Jaundice

Anatomical diagnosis - Hepatitis

Etiological diagnosis - Alcohol induced Hepatitis Pathalogical diagnosis-

Alcohol induced Hepatitis ( cirrhosis of liver with moderate Ascites )

I/O chart Inj. Lasix 40 mg iv stat Tab. Lacilectone 1-1-0 Shrikhandasava 3 tsp tid Tab nirocil 1-1-1 Shivagutika 1-0-1 Inj. Cefaday 1 gm iv BD ( till 14 dose) Inj genta 80 mg iv BD ( 5 dose) Feeding resticted to 1500 ml / day

 Alcoholic Liver disease: Alcohol is metabolized exclusively

by the liver. pathway 1)Alcohol Acetaldehyde ADH This Acetaldehyde adducts with cellular protein in hepatocytes which activates immune system leading to cell injury. Alcohol when metabolized with oxidase enzyme which converts etanol to acetate leading to release of free radicals, leading to lipid preoxidation which induce mitochondrial damage and there by hepatic damage .

 Nadi

78/min Mutra vikruta (2-3 times/day) Mala vikruta Jivha Alipta Shabda prakruta Sparsha Prakruta Drik pita varna in shukla mandala Akriti Madhyama.

Dasa vidha pareeksha Prakriti: pitaja-vataja (chapala gati, chesta bahupralapa, ushna asahishnuta, sheta preeyata, guru gatra, kshuda, sweda adhikata) Vikriti: Hetu: Ahara :- katu, ati ushna, vishama ashana, Akala ashna Vihara:- ati shrama, ati madya sevana, Ratri jagarna Manasika:- Ati vishada, Ati chinta Dosha:- Tridoshaja ( pita ulvanata) Dhatu:- Rasa, Rakta, Mamsa, Medas Desha:- Aanupa

 Kala:- Aadana kala Bala:- Madhyma

Vyadhi bala:- Madhyma

Saara:- Avara(Madya has all opposite guna

to ojas , so on long standing drinking of madya leads to ojo kshaya and thus sapta dhatu saara will be kshaya)

 Samhana:- Madhyma
Pramana:- madhyma

Saatmya:
Satva:

madhyama
avara

Ahara shakti:- Madhyma Vyama Shakti:- Madhyma

Vaya:

Madhyama

 Nidana: Ahara :- katu, ati ushna, vishama ashana,

Poorvaroopa: Roopa.

Akala ashna Vihara:- ati shrama, ati madya sevana, Ratri jagarna Manasika:- Ati vishada, Ati chinta Aruchi, Annanabhilasha, chhardi in morning before brushing Pita varna in netra and mutra, ishat pitata in hasta, udara, shotha in pada. Manda jvara, alpa muutrata, atisara

Upashaya anupashaya: nothing specific

Ati madya. Ati katu ahara, vishma ashana, ati shrama, ratri jagrana chinta

KUMBH KAMALA
Kalantar KAAMALA(Koshtha ashrita kamala)

pitta pradhan dushti with tridosha dushti

Agni dushti
Agni mandhya producing aam Circulation of saama dosha with rakta)

Sthana samshraya in moola of rakta and mamsa causing rakta mamsa dushti Circulation of rakta mala(pitta) with rakta Adhika rakta mala utapatti

Raktavaha sroto dushti

 Dosha:

Tridosha (pitta pradhan- pachaka, bhrajaka, alochaka, vata- vyana, samana kapha- kledak) Dushya: rasa rakta mamsa medas Updhatu twak Mala mutra, purisha Agni: jatharagni , dhatvagni Agnidushti manda Srotas: rasavaha, raktavaha, annavaha Srotodusthi: sanga, vimarga gamna Udbhava sthana: amashaya Sancharasthana koshta Vyakta sthana: tvak, netra, mutra, koshta Rogamarga: Bahya and Abhyantra.

 Shakha ashrita kamala

Halimaka Pittaja madatya janaya kumbha kamala

Disease
Shakha ashrita kamala

Inclusion
Haridra mootra, netra, twak, avipaka, agnimandhya
Pita varna, bala kshaya, mrudu jvara

Exclusion
Kapha vata prakopna is pathology. Vishtabdhata, sweta varchas
Daha, trishna, utsaha kshaya

Halimaka

pittaja madatya janaya Jvara, atisara, haridra varna of tvak kumbha kamala Pita varna of netra, tvak, nakha, mutra, purisha shotha

Pittaja madatya janya kumbha kamala

 Patient is a shop owner. He works for 16 hours i.e. ati

vyama and sleeps for 5hrs in night on long run leads to vata vridhi. He has habit of consuming ati tikshna, katu aahara which vitiate pitta in patient. Patient has habit of consuming madya since 15 years. According to acharya charaka in chikitsa sthana 24th chapter explains that all madyataya are tridosha janaya. Their could be either One dosha ulvanta Two dosha ulvanta Vrudha, vrudhatara and vrudhatama Sama sannipata

 Madya has all opposite gunas to ojas and same guna to

vata thus it does the kshaya of ojas and vridhi of vata. . ./

Person has which increase rajas and which

in turn increase pitta in body. - . . Thus we see the vitiation of all the three doshas . is ( . . )

 is a . . .

..
Koshtashrita kamala is bahu pittaja vyadhi.

the patient should be given abhyantara snehapana with panchgavya ghruta, mahatiktaka ghruta and after that mrudu virechana should be done. Virechana can be given with trivrut kalka with triphala kwatha or danti 24 gms with 48 gms of guda After this patient should follow diet.

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